Prior authorization requirements for angiographic evaluation of stenotic or thrombosed dialysis circuits

Effective August 1, 2020, Anthem Blue Cross and Blue Shield (Anthem) will change prior authorization (PA) requirements for angiographic evaluation of stenotic or thrombosed dialysis circuits. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage. If you do not comply with these new requirements, Anthem may deny your claims.

 

PA requirements will be added to the following codes:

• 36901
• 36902
• 36903
• 36905
• 36906
• 36907
• 36908

 

To request PA, you may use one of the following methods:

• Web – availity.com*
• Fax – 1-800-964-3627
• Phone – 1-800-901-0020

 

Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers by accessing the Precertification Lookup Tool at www.anthem.com/inmedicaiddoc. Contracted and non-contracted providers who are unable to access the Availity Portal can call the appropriate Provider Services number:

• Hoosier Healthwise: 1‑866‑408‑6132
• Healthy Indiana Plan: 1‑844‑533‑1995
• Hoosier Care Connect: 1‑844‑284‑1798